Use of clinical toxicology resources by emergency physicians and its impact on poison control centers

Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019

OBJECTIVE

To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019.

STUDY DESIGN

We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet "exposure," which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison.

RESULTS

A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical "effect," defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008.

CONCLUSIONS

Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.

Cost Benefits of the Drug and Poison Information Centre in Preventing Unnecessary Hospitalisation: The Singapore Experience

Background

The Drug and Poison Information Centre (DPIC) in Singapore was piloted as a new service in April 2004. This study evaluated the cost benefits of its interventions in the first two years of its operation.

Method

A two-year retrospective review of DPIC call records was performed and the following outcome measures were noted: (A) proportion of patients who were managed onsite and hence did not need to attend the emergency department (ED); and (B) proportion of patients who were managed in the ED without the need for admission. Cost savings were calculated based on admission costs for patients with poisoning, including other out-of-hospital costs. This amounted to savings of S$1390 and S$1170 for patients who fulfilled outcome measures A and B respectively. Savings for the hospital was S$1477 per case. The cost of operating the DPIC over the same period was S$507,922.

Results

There were 831 calls on acute toxic exposures over the study period. Of these, 115 and 405 patients fulfilled outcome measure A and B respectively with consequent cost savings of S$159,850 (115 x S$1390 per patient), and S$473,850 (405 x S$1170 per patient). The hospitals saved S$768,040 (520 x S$1477) from prevented admissions. Excluding operating cost, this gave net savings of S$893,818 over the two years from DPIC interventions.

Conclusion

The cost savings from DPIC services is evident from this study. This translates to more effective use of limited healthcare resources.

Standardized pill imprint codes: a pharma fantasy

To safely use medications, professionals and consumers need usable and reliable methods to identify tablets patients are prescribed and taking. Currently, each manufacturer assigns its own identifying codes and symbols. Standardization of the system for identifying solid dosage forms is a goal that has been widely advocated, yet stubbornly resistant to progress. Physicians, pharmacists, and consumers attempting to identify pills must use various methods which have shortcomings in ease of use, availability, and accuracy. Arguments have been advanced, particularly by pharmaceutical manufacturers, that evidence of unworkability of the current system is not compelling, and costs of retooling current manufacturing processes could be prohibitive. These issues are currently being explored by a task force led by the U.S. Pharmacopeia Safe Medication Use, and Pharmaceutical Forms Dosage Expert Committees. This paper presents a fictitious case study of an elderly patient succumbing to digoxin overdose illustrating the dilemmas posed in the tablet-imprint debate.

Voluntary self-poisoning as a cause of admission to a tertiary hospital internal medicine clinic in Piraeus, Greece within a year

BACKGROUND

Out of 1705 patients hospitalised for various reasons in the 3rd Internal Medicine Department of the Regional General Hospital of Nikaea, in Piraeus, 146(8,5%) persons were admitted for drug intoxication between November 1999 and November 2000.

METHODS

On average, these persons [male 50(34,2%)--female 96(65,8%)] were admitted to the hospital within 3.7 hours after taking the drug.

RESULTS

The drugs that were more frequently taken, alone or in combination with other drugs, were sedatives (67.1%), aspirins and analgesics (mainly paracetamol) (43.5%). 38.3% of patients had a mental illness history, 31.5% were in need of psychiatric help and 45.2% had made a previous suicide attempt. No death occurred during the above period and the outcome of the patients' health was normal. After mental state examination, the mental illnesses diagnosed were depression (20.96%), psychosis (15.32%), dysthymic disorder (16,2%), anxiety disorder (22.58%) and personality disorder (8.87%).

CONCLUSIONS

Self-poisoning remains a crucial problem. The use of paracetamol and sedatives are particularly important in the population studied. Interpersonal psychiatric therapy may be a valuable treatment after people tried to poison themselves.

Poison control centers and state-specific poisoning mortality rates

OBJECTIVE

The purpose of this study was to compare poisoning mortality rates of states served by a poison control center certified by the American Association of Poison Control Centers (AAPCC) to those that are not served by a certified center because health policy has been based on certification status.

METHODS

Poisoning mortality rates from 1993 to 1997 were obtained from a public use database of death certificates and were stratified by state and circumstance. Each state was classified as being fully served, partially served, or not served by an AAPCC-certified center. States in one category of service for the entire 5 years were selected for analysis.

RESULTS

During this 5-year period, 39 states exhibited a consistent category of poison control center services. The mortality rates per 100,000 population during these 5 years were 5.93, 6.12, 6.01, 6.23, and 6.68 respectively (P <0.05) for all 39 states. The mean 5-year mortality rate for states with certified poison control center services (7.08 +/- 2.59; n = 17) was higher (P <0.05) than those with noncertified service (5.17 +/- 1.46; n = 15) but not significantly different from those with partial certified service (6.25 +/- 1.75; n = 7).

CONCLUSION

Increased poisoning mortality rates were associated with AAPCC certification status and year. Poisoning mortality rates may not be an appropriate outcome measure of the impact of poison control centers, AAPCC-certification notwithstanding, at this time. Basing poison control center-related policy on state-specific poisoning mortality rates can not be supported by these findings.

Sources of information for acute poisoning in accident and emergency departments in Dublin, Ireland

BACKGROUND

Access by accident and emergency staff to up-to-date information on poisoning is essential for optimal management of acute poisoning. Apart from the National Poisons Information Centre, other information sources can be used. The objectives of the study were to identify sources of information on acute poisoning in accidents and emergencies and satisfaction with their use.

METHODS

In a cross-sectional survey of medical staff of accidents and emergencies in Dublin in 1997, data were collected by interviewer-administered questionnaire.

RESULTS

All 11 accidents and emergencies participated, with a staff response rate of 95%. One hundred and twenty-eight respondents were included. Ninety-seven percent had managed cases of poisoning (median 3 per week). The National Poisons Information Centre had been used by 93% of respondents, textbooks by 80%, paper database by 63%, and disc database (CD-ROM) by 10%. Of those managing cases, the National Poisons Information Centre would always be contacted by 23% and by 53% in most cases. The National Poisons Information Centre and CD-ROMs were rated the most useful sources of information. Information provided by the National Poisons Information Centre was considered sufficient by 98% of respondents. Thirty-three percent considered that advice should always be confirmed by fax. Limitations with the National Poisons Information Centre were described by 55% (e.g., manual transcription), with textbooks (e.g., limited content) by 83%, with paper databases (e.g., incompleteness) by 85%, and with CD-ROMs (e.g., time-consuming) by 54%.

CONCLUSION

For the optimal management of acute poisoning, direct access to computerized information databases in accidents and emergencies combined with telephone access to the National Poisons Information Centre is required, with information available in hard copy.

Emergency department poison advice telephone calls

STUDY OBJECTIVE

Requests for medical advice regarding treatment of poisonings are common in emergency departments. Although there are designated poison centers (PCs), most EDs are recognized by the community and medical staff as a poison information resource. The purpose of this study was to evaluate the accuracy and consistency of poison information given by ED personnel.

DESIGN

A prospective, stratified-sample, telephone survey over a 6-month period of requests for medical advice about simulated poison ingestions.

PARTICIPANTS

Fifty-two hospital EDs in urban and rural Illinois, all three PCs in Illinois, and three PCs from Indiana, Wisconsin, and Michigan.

RESULTS

Hospital EDs responded correctly to only 100 of 156 calls (64.2%). PCs responded correctly to 17 of 18 calls (94.4%), whereas teaching hospitals responded correctly to 15 of 30 calls (50%, P = .002). ED night shift personnel were 5.5 times more likely to respond incorrectly than were personnel on other shifts (95% confidence interval, 2.72 to 11.12). Forty-eight percent of all calls to EDs resulted in advice to call the regional PC.

CONCLUSION

Poison advice by ED personnel proved to be inaccurate and inconsistent. As a result, patients may be better served if advice calls are redirected to regional PCs.

The arrival of the ED-based POISINDEX: perceived impact on poison control center use

The purpose of this study was to determine the prevalence of emergency department-based POISINDEX (Micromedex Inc, Denver, CO) and assess its perceived impact on use of poison control centers. Survey methodology was used. A written questionnaire was distributed to all emergency departments (EDs) in the state of New York. ED directors or their designee (n = 239) were surveyed regarding the presence of POISINDEX in their ED and their perceptions of its impact on ED use of poison control centers. Completed questionnaires were returned from 180 of 239 (75%) EDs. Of the returned questionnaires, 42 of 180 (23%) have their own POISINDEX. In 32 of 42 (76%) of these EDs that have their own POISINDEX, it was perceived that ED-based POISINDEX decreased poison control center use. Use of ED-based POISINDEX may decrease ED use of poison control centers.